Alcohol, drugs, tobacco and gambling form a lens for the Nordic welfare states’ biggest challenges

The Nordic citizens’ substance and tobacco use, as well as their gambling habits, are associated with some of the biggest challenges that the welfare society faces in the 2020s. Together, alcohol, drugs, tobacco and gambling make up a lens, through which the Nordic countries’ resilience and accountability can be assessed. Let us call this lens the ADTG lens and take a look at how it is entangled with the challenges of the welfare state.

The development of demographic and economic dependency ratios is a predicament for the Nordic welfare states as it introduces difficulties for maintaining a generous public sector in view of a declining tax-paying workforce and ageing population. This places an increased burden on what is in economic terms referred to as the productive part of the population. ADTG is entangled with the maintenance of the upbringing of the young and the economically dependent in different ways. Substance use and unhealthy habits among citizens cause early deaths, accidents, criminality and stresses healthcare and social services. To prevent ADTG-related harm throughout the citizens’ life course is part of a larger social contract regarding preconditions for well-being and good health in all phases of life.

Expenses from ADTG-related non-communicable diseases and absence from work are strains on the Nordic countries. They go hand in hand with increasing general mental health burden, which is prevalent e.g. among young adults who are just starting out in occupational life. This is a generation that is under a cross-pressure that can arguably be seen to be reflected in work motivation and work-related satisfaction (e.g., Eskildsen et al., 2004).

Poor mental health is associated with many different co-morbidities known to have a strong correlation with substance use and addictive behaviour (Lyyra et al., 2021; Wahlbeck et al., 2011). A rise in the use of prescription drugs is worrying North European authorities. Elderly citizens have a higher use of psychotropic drugs and alcohol consumption than previous generations (e.g., Bye & Moan, 2020). Digital habits and an increase in cannabis use among younger citizen are being monitored from the perspective of documented psychological problems. A new more marginal phenomenon that maybe reflects the desperation that citizens experience due to absence of help is the increase in self-mediation through psychedelics.

The use of substances and sale of illicit drugs are associated with socioeconomic and health-related inequality, increased urban segregation and an increasingly elusive logic of crime in socially vulnerable areas. There are massive organisational challenges for the Nordic authorities in providing services that target complex problems and even out inequalities.

We know that access to interventions is unequal among citizens in view of socioeconomics and between women and men. Through case studies, interviews and survey investigations, and document analyses, Nordic researchers have studied reforms (Storbjörk, 2014), integrated service solutions (Matscheck & Piuva, 2022), social work in municipalities (Stenius & Storbjörk, 2023) and organisational tensions within addiction treatment (Storbjörk, 2020). This research has functioned as an important warning signal for the trends in governance and service production that create inequality and divides and threatens to erode the rights of the citizen.

Another type of unfair treatment has been witnessed in the treatment of suspects of drug use or crimes. Police control through drug tests is strongly linked to geographic location, something that has led to young people who live in socially vulnerable areas becoming significantly more often subject to this form of control, and the drug tests in these areas show negative results relatively more often (Estrada et al., 2022).

The Nordic countries are dependent on taxations, revenues and licence fees from the commerce with alcohol, tobacco and gambling. These state incomes, which vary depending on control policy system, can cause ethically questionable dependencies that are hard to justify in view of the welfare states’ tasks (Egerer et al., 2018; Kankainen et al., 2021). Nowadays, there are new global industries that sell their products online and offer ways for consumers to acquire ADTG goods in ways that do not give any revenues to the State and which can even be illegal.

Nordic researchers can stay on top of the developments and help solve larger societal problems by continuing to monitor developments and keep alert regarding new trends. In this issue of NAD, McInerney and colleagues (2023) map the characteristics of people who have received treatment for late-onset problem drinking and alcohol use disorder. Vallentin-Holbech and colleagues (2023) write about how hazardous alcohol use among Danish adolescents during the second wave of COVID-19 was linked to (absence of) social life. Karjalainen and colleagues (2023) present the findings from a study that analyses the use of illicit stimulants by triangulating wastewater, general population survey and web survey data. Koponen and colleagues (2023) have compared adverse childhood experiences and neurodevelopmental disorders among youth with and without prenatal substance exposure. In an overview report, Rognli and colleagues (2023) compare intervention simulations of employment support integrated in the treatment for substance use.